The goal of this Mentored Patient-Oriented Research Career Development Award (K23) is to understand the risk and protective factors predicting adolescents' adjustment to type 1 diabetes (T1D). Adolescents with T1D are at risk for poor adjustment, including both physiological (i.e., poor metabolic control) and psychosocial outcomes (e.g., depressive symptoms, poor quality of life). The overarching framework guiding this research is the Transactional Stress and Coping Model, which views chronic illness as a potential stressor to which children and families attempt to adapt. Child adjustment is thought to be mediated by child and family adaptational processes and moderated by demographic and illness variables. The proposed study uses a multi-method, prospective approach to examine the effects of three broad categories of risk and protective factors as predictors of adolescents' physiological and psychosocial adjustment to the illness over 12 months: a) Coping Strategies (primary control, secondary control, and disengagement coping); b) Family Functioning (maternal involvement, parent-child conflict); and c) Maternal Adjustment (symptoms of depression and anxiety). The K23 Award will be conducted at Yale University with a multidisciplinary team of mentors, consisting of a primary mentor, Margaret Grey, Dr.PH, RN, and two secondary mentors, William Tamborlane, MD, and Alan Delamater, PhD. Each of these mentors are experts in their respective fields and will be able to provide the applicant with additional instruction and experience in: (1) the pathophysiology of T1D in adolescents; (2) translating the applicant's previous research on risk and protective factors in children and adolescents to longitudinal research in adolescents with T1D; and (3) advanced manuscript and grant writing skills. The acquisition of these skills will prepare the applicant to build a research career focused on developing family-based cognitive-behavioral preventive interventions for children and adolescents at risk for negative psychosocial and physical outcomes, particularly adolescents with chronic pediatric conditions, such as T1D. RELEVANCE (See instructions): This study has the potential to greatly improve the quality of life in adolescents with chronic illness and their families. It is expected that the study to follow will be a pilot and feasibility study of a family-based cognitive-behavioral preventive intervention for adolescents with Tl D and their mothers, focusing on improving adolescents' use of adaptive coping, relieving parents' distress, and promoting the best parenting behaviors. PUBLIC HEALTH RELEVANCE: This study has the potential to greatly improve the quality of life in adolescents with chronic illness and their families. It is expected that the study to follow will be a pilot and feasibility study of a family-based cognitive behavioral preventive intervention for adolescents with Tl D and their mothers, focusing on improving adolescents' use of adaptive coping, relieving parents' distress, and promoting the best parenting behaviors.